Medicaid Eligibility in New York

Eligibility Team
Researcher & Writer
December 12, 2017

In  New York, Medicaid is a healthcare option that is government sponsored  and covers the medical expenses for patients who are low income and who  could not afford healthcare otherwise.

New York’s Requirements for Medicaid Qualification

Eligibility for New York Medicaid is something that is determined by a  few different factors that have been developed by the New York state  department. The benefits given by Medicaid will aid those who are unable  to pay their medical bills, such as those on SSI (Supplemental Security  Income) and others who meet the requirements for eligibility. Before  those requirements even come in to play though, you first have to fall  into one of the following categories:

  • Adults who have an income that does not exceed 138% of the FPL (Federal Poverty Level)
  • Infants and/or women who are pregnant whose income does not exceed 218% of the Federal Poverty Level

To qualify for Medicaid - aside from being in one of the preceding  two categories - you need to meet predetermined requirements for  eligibility. You have to reach, without exceeding certain income  thresholds. Additionally, you have to prove that you are a citizen of  the US as well as proving that you are a state resident. You also need  to have documentation regarding your living situation and your marriage  license if you are married, along with your SSN (Social Security  Number).

How to Apply for Medicaid in in New York

Due to the fact that you must stick to specific instructions with  regards to submitting your paperwork, the application guidelines are  different in New York than those in other states. The qualifying  criteria are actually spread into two separate groups. These are MAGI  (Modified Adjusted Gross Income) and non-MAGI groups. You have to file  differently depending on which group you fall into.

When it comes to MAGI application guidelines, this group includes  foster children, children under 19, beneficiaries of the FPBP (Family  Planning Benefit Program), relatives of caregivers or parents, women undergoing fertility treatments and  pregnant women. If you fall into this group, you will have to apply for  the Medicaid program via the New York State Department of Health Marketplace.

To be eligible under the non-MAGI eligibility group, you must be a recipient of one of the following:

  • Medicaid Cancer Treatment Program
  • AIDS Health Insurance Program
  • Social Security Income
  • ADC-related medical needy, or the
  • Medicare Savings Program

If you belong to this group, you should apply for Medicaid at your local Department of Social Services.

The New York Medicaid Application can be filed online, in person, by mail, or on the phone. If you decide  to apply in person, you may do so at the District Service Office in  your area. If you decide to file by mail, simply download and fill out  the application and then send the completed application to the District  Social Service office in your area. To apply by phone, call the New York  State Department of Health for the proper phone number for your area.  Make sure that you have all of the information that you will need on  hand before calling to file an application.

What Does Medicaid Cover in New York?

Medicaid gives beneficiaries quite a broad range of coverage with  regards to health insurance. This includes visits to the doctor,  hospital stays, care in a nursing home, home health care, and more.

Medicaid also pays for prescriptions. If you ever have to pay a copay, it will be one that is relatively small.

Income Requirements for New York Medicaid

The income requirements for Medicaid are based on various resource  levels for the state. For example, the income requirements for people  who are over the age of 65, blind, or otherwise disabled are different  than they are for people who are single or who are married but without  any children. Additionally, assets are to be accounted for. When it  comes to getting around the Medicaid financial requirements, you can  only have more money if you are over 65, a child, pregnant, blind, or  otherwise disabled.

In general, you can only have income that is not over 138% of the FPL  for your size family or household. If you would like to see specifics  as far as what you can earn for your household size, click here.

How Much Does Medicaid Cost in New York?

Medicaid coverage allows for families with a low income as well as  low-income individuals to get quality and affordable healthcare. Some of  the services offered by Medicaid are free, but others will require  co-payments that can vary.

Cost and Coverage of Medicaid in New York

Estimates for the cost of Medicaid can vary depending on things like  the individual patient and services needed. These copays will be small.  People who will receive free healthcare from Medicaid include those who  are under the age of 21, women who are pregnant, and patients who are in  long-term care.

As far as coverage goes, Medicaid typically pays for most medical  services, along with any medications and supplies that are needed. This  includes coverage for things like:

  • Family planning services and prenatal care
  • Ambulance rides to the hospital in emergency situations
  • Public transportation or car mileage to the patient’s medical appointments
  • Medicines, supplies, medical equipment, and appliances
  • Early screening, diagnosis, and treatment for beneficiaries who are under 21
  • Other various services that might be needed

Prescription Drugs with Medicaid in New York?

New York Medicaid does pay for prescription drugs. There might be a  small copay depending on the drug and the benefits of the patient.

Which Medicaid plan is best in New York?

The best option when it comes to Medicaid in New York comes down to  which one you qualify for. You might only qualify for one and that is  the one you will get. If you have an option, it is best to discuss the  options with your caseworker once you have been approved.

Eligibility Team
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Eligibility Team
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